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Get Healthy, Get Declined | Health

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Get Healthy, Get Declined
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Get Healthy, Get Declined

Recently I was working with a 48 year old woman, Leslie, transitioning from a group to an individual plan. She applied to two different carriers and was declined by both. One of the insurers was her current group health plan carrier. My client takes two medications, one for high blood pressure and another for depression. The mild anti-depressant is reasonable and temporary since she is going through a divorce. She exercises daily, height-weight proportional and does not smoke or drink. “Why are you declining her?”, I growl as I read the e-mail notification.

COBRA coverage will be available to her but that is expensive and she is trying to save a little money now that she is single and living alone. Since I had other clients with far heavier medications and issues get underwritten for health insurance, I never gave it a thought that she would be declined, twice!

Here is a woman who is proactive about her health, making sure she addresses medical conditions before they worsen and understands the necessity of health insurance. It seems as if she is being penalized because she is taking care of herself. The decline letters specifically mentioned her current prescriptions. What does a hard working woman have to do to get a break in our screwed up health insurance market place?

What usually happens is that a person with a few prescriptions will be ‘rated up’. In other words, they will be offered a monthly premium 10% – 50% above the standard rate for a perfect human; one with no problems. However, in my client’s case, there was no ‘rate up’ offered, straight decline. I have worked with people with serious medical conditions and prescriptions get approved or at least offered health insurance with a rate increase.

While I am not given to conspiracy theories, I am beginning to smell a rat. Both of the insurers know that she is transitioning from a group plan which means she must be offered COBRA. The COBRA option and ultimately a HIPAA eligible plan will mean more revenue for them. Could it be that they are discriminating against her because they know COBRA is available and she could afford to pay the premiums? It troubles me to think that might be their motive. But I am at a loss for any other explanation.

Here is a perfect example of someone trying to work in the open market to purchase a product and save some money. The difference between COBRA and HIPAA and an individual plan is between $300 and $500 per month. That is a tremendous amount of money that she could save or perhaps spend in the local economy. Her other alternative is to let her insurance lapse and then after six months apply for the Pre Existing Condition Insurance Plan in California. Unfortunately, she is more honorable than some insurers and would never take that course of action.

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